Psychiatric Discharge Checklist: Don't Leave the Hospital Without These Three Questions Answered

We sat down with Dr. Gabriela Asturias, a psychiatry resident at Stanford Hospital, to ask her how families can advocate for their loved ones to ensure they have the information they need before leaving the hospital.

During your family member’s stay, you will receive varying levels of support from the hospital staff. Depending on how well-resourced the hospital is, there may or may not be built-in practices to help you address each of these questions. Sometimes, steps get missed, so advocating for your loved one is always important. Don't hesitate to ask for assistance politely.

Important: To discuss patient information with hospital staff, your family member has to consent and sign a release of information for each family member who will be allowed to talk to their treatment team. 

1. Understand the Reason for Admission and Therapeutic Goals

The first essential question is: “Why was my loved one admitted? And what is the care team looking to accomplish?”

Dr. Asturias emphasizes the importance of understanding the reasons behind the admission and the goals set for the hospital stay. This knowledge provides a foundation for understanding the effectiveness of the treatment and ensures that the patient and their family are on the same page as the healthcare providers. An example of an answer to this question might be: “You were admitted for severe depression and suicidal ideation. The care team aims to optimize medications to stabilize your mood, have a safety plan, and set up outpatient follow-up care after discharge.” 

If your loved one is placed on an involuntary hold, ask what it means and for how long it lasts. Treatment teams only place these holds when criteria are met for danger to self, danger to others, or grave disability. The specifics vary by state. Also, it is important to clarify if the involuntary hold includes providing medications involuntarily; in most states, the hold only permits hospitalizing a patient, but they still have to consent to receive any medications unless another legal process is pursued.

When it’s time to be discharged, ask the treatment team what was accomplished during the stay. This is where you can reference the original goals that were stated. If these goals were not met, this is the moment to ask questions to understand why the plan changed. Remember, as the treatment team gets to know the patient better, it is normal for goals to change. For example, you might ask: “We initially aimed to stabilize my mood, but I still feel very depressed. What steps can we take moving forward?”

2. Understand Your Treatment Plan Moving Forward

Understanding the treatment plan and medications your loved one will be receiving after discharge is essential.

Medication Management: Ask the treatment team to explain each medication's purpose and potential side effects. It’s crucial to understand the importance of adherence to the medication regimen to avoid relapse or worsening of symptoms. A good question might be: “Can you explain what each medication is for and what side effects I should watch for?”

Follow-up Care: Ensure you know the type of care recommended after discharge and why it’s important. For example, your loved one needs an outpatient psychiatrist to manage the medications that were started during their hospital stay. Some types of care that they may be referred to: “Intensive outpatient program, psychiatrist, psychologist, or residential treatment program.” If you do not already have an appointment with the suggested type of care, ask to meet with a social worker to help you set up an appointment. For example, you might ask: “Can you help me schedule my first appointment with the outpatient psychiatrist?” Some hospitals may not have a social worker available, so you can use online directories (miresource.com) or contact your insurance plan for assistance. 

Crisis Plan: Understand what steps to take if a crisis occurs after discharge. This might include knowing who to call and where to go if symptoms worsen or there's an emergency. Ask the team, “What should I do if I experience a crisis after leaving the hospital?” In some cases, a safety plan may be drafted for patients with suicidal ideation that includes steps to take and numbers to call; ask if you can have a copy.

3. Address Financial and Social Concerns

Worried about paying for care? Don’t be shy about bringing up these concerns with your care team.

Financial Assistance: The hospital may have resources that can help you enroll in Medicaid (if you are eligible), connect you to nonprofits or grants to help cover the cost of your care. You might say: “I’m concerned about how I will pay for my medication and therapy. Can you help me find financial assistance?”

Social Support: If housing, transportation, or food are concerns, be sure to let the care team know so that they can assign a social worker to assist you with these items. For instance, you could ask, “I don’t have reliable transportation to my appointments. Can you help me find a solution?”

Community Resources: Inquire about any community resources, support groups, and peer support that might be beneficial. Support groups can provide a network of individuals who understand what you are going through and can offer advice and encouragement. Ask the team: “Are there any local support groups or community resources you recommend?”

Some last thoughts

Leaving the hospital after a psychiatric stay can be overwhelming for your loved one, but by ensuring you have answers to these three critical questions, you can feel more prepared and confident in supporting your family member’s health moving forward. Dr. Asturias reminds us that being proactive and advocating for your loved one is key to successfully transitioning from hospital to other settings.

By understanding the reasons for admission, the treatment goals, and the plan for ongoing care, you can support your loved one in taking control of their mental health journey. Don’t forget to address any financial or social concerns with their care team to ensure a smooth transition.

Need help finding follow up care? MiResource can help you find a provider or treatment program covered by your insurance.